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PubMed1975

Increased uptake of 99mTc-sulfur colloid in vertebral compression fractures.

Increased uptake of 99mTc-sulfur colloid in vertebral bodies of two patients with vertebral compression fractures was noted on a liver-spleen scan. This finding has not previously been reported in the literature. The mechanism of localization of 99mTc-sulfur colloid in bone marrow depends on regional blood flow and increased reticuloendothelial and phagocytic cell activity. Both mechanisms are felt to be involved in these cases. In fractures, hyperemia and phagocytic activity are transient phenomena and therefore the above observations may be useful in determining fracture age.

Adult↗
PubMed1983

Unrecognized spinal instability associated with seemingly "simple" cervical compression fractures.

This paper described 27 patients who had seemingly stable compression cervical vertebral fractures. All were treated in cervicothoracic orthoses. None was initially treated in a Halo device or with surgery. Twenty patients were stable and healed without progressive displacement, angulation, or pain. One patient demonstrated an angular deformity, which spontaneously stabilized within six months with anterior bony ankylosis in a kyphotic position. Six patients demonstrated persistent progressive post-injury instability related to posterior ligament rupture. As muscle spasm diminished, the patients could be given a more reliable flexion-extension radiographic examination, unmasking the hidden posterior instability. Five of the six who demonstrated this instability were disabled because of pain. Two of the six patients were treated with a two-segment fusion. The other four have had fusion recommended and are currently being followed clinically. This paper emphasizes the need for better initial criteria of potential instability and close follow-up of patients with simple compression fractures of the cervical spine.

Adolescent↗
PubMed2003

Minimally invasive treatments of osteoporotic vertebral compression fractures.

STUDY DESIGN: A literature review of experiences with vertebroplasty and kyphoplasty for treating symptomatic, osteoporotic vertebral compression fractures (VCFs). OBJECTIVES: To summarize the advantages and disadvantages of kyphoplasty and vertebroplasty. SUMMARY OF BACKGROUND DATA: Osteoporotic VCFs are a leading cause of disability and morbidity in the elderly. The consequences of osteoporotic VCFs (pain and often progressive vertebral collapse with resultant spinal kyphosis) adversely affect quality of life, physical function, mental health, and survival. Vertebroplasty and kyphoplasty are minimally invasive procedures for treating painful fractures. Vertebroplasty entails the percutaneous injection of bone cement into the fractured vertebra in attempts to stabilize the fracture and reduce pain. Kyphoplasty addresses pain and kyphotic deformity by the percutaneous expansion of an inflatable bone tamp to effect fracture reduction before cement deposition in a fractured vertebra. METHODS: A literature review of surgical techniques, indications, clinical results, and complications for vertebroplasty and kyphoplasty. RESULTS: Studies of vertebroplasty and kyphoplasty have reported excellent pain relief and improved function in most patients with osteoporotic VCFs. Vertebroplasty has the advantage of being relatively quick and inexpensive. Kyphoplasty, while associated with increased cost and surgical time, offers the potential to improve spinal alignment. In addition, by creating an intravertebral cavity, kyphoplasty reduces the risk of extravertebral bone filler extravasation. CONCLUSIONS: Vertebroplasty and kyphoplasty are currently used to treat osteoporotic VCFs with successful short-term results. Prospective, randomized studies comparing these procedures to one another and comparing their long-term outcomes to conventional medical management are required to define precise roles of these exciting treatments in the spine physician's armamentarium.

Bone Cements↗
PubMed2005

A novel percutaneous system for bone graft delivery and containment for elevation and stabilization of vertebral compression fractures. Technical note.

OBJECT: Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat persistently symptomatic vertebral compression fractures (VCFs). Both interventions usually involve injection of polymethyl methacrylate (PMMA). The purpose of this technical note was to review the theory and surgical technique for a novel percutaneous system for fracture reduction and stabilization of VCFs by using bone graft. METHODS: This technical note highlights the Optimesh system as an alternative method of minimally invasive VCF reduction and stabilization with the delivery of a bone graft containment device. Instead of using PMMA as in vertebroplasty or kyphoplasty, this system allows the delivery of allograft and/or autograft bone, with its osteoinductive, osteoconductive, and osteogenic properties. CONCLUSIONS: This system allows for restoration of sagittal alignment of the spine with direct control of bone graft delivery by using a mesh graft containment device that allows for ingrowth of new bone and vascular tissue.

Bone Cements↗
PubMed1992

[Dorsal compression fractures of the distal radius metaphysis. Long-term follow-up with conservative therapy].

Conservatively treated compressed fractures of the distal radius dorsal metaphysis healed despite primarily good reduction and consequent treatment with a decrease in dorsal length. The amount of this decline depends on the primary loss of dorsal length. If the fracture showed a loss of dorsal length at the time of the accident of up to 2 mm, the long-term results were almost anatomical. If there was primarily a larger loss of dorsal length, a decline of the distal fragment into the dorsal cave resulted. Most of the dorsal length regained after reduction was lost when the cast was removed. The long-term follow-up examinations were made after about 9 years.

Adolescent↗
PubMed1994

Compressive fracture resistance of the marginal ridge in large Class II tunnels restored with cermet and composite resin.

Compressive fracture resistance of the marginal ridge was studied in large tunnel preparations, before and after restoration with cermet (Ketac Silver, ESPE), a universal hybrid composite (Superlux, DMG) and an experimental composite. Each group was represented by six tunnels in extracted upper premolars. The tunnels were prepared by the use of round burs up to size #6. Remaining ridge width was 1.5 mm and ridge height 1.7 mm in the contact area. The ridge was loaded to fracture by a rod placed perpendicular to the ridge. Generally this resulted in a shear fracture of the restoration. There was no significant reinforcement of the ridge by the cermet whereas the composites both reinforced by the same magnitude, averaging 62%. It was concluded that the ridge could be considered a "megafiller" where contact need to be preserved and contour protected against proximal and occlusal wear of the restoration. Clinically there would therefore be good reasons to save even ridge areas with very low inherent strength. Based on the present study composite resin might therefore be the filling material of choice for such tunnel preparations.

Bicuspid↗
PubMed2003

Intracorporal bone grafting for vertebral compression fractures with intraosseous vacuum phenomenon.

From April 1998 to January 2000 we treated 14 patients with vertebral osteoporotic compression fractures and intraosseous vacuum phenomenon with intracorporal bone grafting using a mixture of autogenous bone graft and calcium sulfate and posterior instrumentation. The mixture was packed into the fractured vertebral body through two tunnels created in the pedicles. Eleven patients were followed for a minimum of 24 months. All vertebral bodies healed. There were no perioperative complications. The average vertebral height restoration was 31%. On the visual analogue scale, there was an improvement of average 37 clinical scores.

Aged↗
PubMed1999

Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study.

OBJECTIVE: To assess the efficacy and safety of percutaneous vertebroplasty in osteoporotic vertebral compression fractures responsible for severe and persistent pain. METHODS: Sixteen patients were included in this open prospective study. Inclusion criteria were: one or 2 vertebral fractures responsible for severe pain, i.e., higher than 50 mm on a visual analog scale (VAS: 0-100 mm), scores 3, 4 or 5 according to the McGill-Melzack scoring system, and evolving for more than 3 months. Assessment criteria were the changes over time (Days 3, 30, 90, 180) in VAS and McGill-Melzack scoring system. The changes over time in a generic health status instrument score [the Nottingham Health Profile (NHP)] were also assessed. Statistical comparisons were performed using the Wilcoxon T test. RESULTS: There were 9 women and 7 men: postmenopausal osteoporosis (n = 7), corticosteroid induced osteoporosis (n = 2), and male osteoporosis (n = 7). Vertebroplasty was performed in 20 vertebrae. A statistically significant decrease of both VAS (-53%, p < 0.0005) and McGill-Melzack scoring system (p < 0.005) was observed at Day 3. The results were also significant at Days 30, 90, and 180 for both scales (p < 0.005 and p < 0.01, respectively). A significant decrease over time for 5/6 dimensions of the NHP score was also noted: pain (p < 0.01), physical mobility (p < 0.05), emotional reactions (p < 0.05), social isolation (p < 0.05), and energy (p < 0.05). We observed no adverse event, and no vertebral fracture has occurred after 6 months of followup. CONCLUSION: Percutaneous vertebroplasty is a useful and safe procedure for treating persistent painful osteoporotic fractures. Controlled studies with longterm followup are required.

Aged↗
PubMed1999

Nontraumatic lumbar vertebral compression fracture as a risk factor for femoral neck fractures in involutional osteoporotic patients.

To screen a potential risk factor for femoral neck fracture, we characterized lumbar vertebral fractures in 120 patients with femoral neck fractures (19 men, 101 women; mean age, 78.7 years) by investigating the frequency of patients with lumbar vertebral fracture, the number of vertebral fractures per patient, and the severity of deformity of the fractured vertebral bodies. These findings were compared with data gathered from a population of age- and sex-matched control patients (20 men, 89 women; mean age, 77.6 years) who had no evidence of femoral neck fracture. The heights of the anterior and posterior walls together with the midpart of the lumbar vertebrae were measured on lateral radiographs to identify fractures. The extent of height loss in the fractured vertebrae was calculated for each group. The incidence of patients with vertebral compression fractures was significantly higher in the femoral neck fracture group than in the control group (65.0% vs 41.1%). In terms of age, the difference in the incidence of vertebral fractures in the two groups was greater in the less aged (60-79 years old) than in the more aged (>80 years old) population. The mean number of lumbar vertebral fractures was also significantly greater in the femoral neck fracture group than in the control group (1.59 +/- 1.39 vs 0.75 +/- 1.19; P < 0.001). The incidence of more deformed vertebral fractures, which were defined as a vertebral height loss of more than 50%, was also significantly higher in the group with femoral neck fracture than in the control group (23.0% vs 7.3%). Based on these results, we concluded that multiple and more severely deformed vertebral fractures might represent a high risk for femoral neck fracture, particularly in patients less than 79 years of age. Care measures that encompass fall prevention and protection of proximal femurs in addition to drug therapy for osteoporosis should be recommended to individuals in this category.

Age Factors↗
PubMed1994

Vertebral compression fractures: how to manage pain, avoid disability.

About 25% of U.S. women over age 50 will suffer one or more vertebral compression fractures related to osteoporosis. Vertebral fractures may be biconcave, anterior wedge, or crush deformities. A fracture is most often precipitated by putting a load on outstretched arms (eg, while raising a window). Back pain is usually incapacitating for a few weeks, then diminishes in severity but remains intense for 2 to 3 months. Acute complications include transient ileus, urinary retention, or (rarely) cord compression. Long-term effects include kyphosis, deconditioning, insomnia, and depression. Initial treatment includes bed rest, pain management with local and systemic analgesia, bracing to improve comfort, and patient reassurance. Long-term management includes spinal stretching exercises, walking, and treatment of underlying osteoporosis with calcitonin or estrogen in selected patients.

Acute Disease↗
PubMedDate not supplied

Current medical, rehabilitation, and surgical management of vertebral compression fractures.

Approximately 25% of women over the age of 50 in the United States will suffer one or more vertebral compression fractures (VCFs) related to osteoporosis. VCFs are the most common of all osteoporotic fractures, with an incidence of approximately 700,000 annually. Such a fracture may cause significant pain, disability, and loss of general health and mobility and may lead to a progressive decline in quality of life. This is a review of the clinical literature on VCFs, including patient presentation, methods of diagnosis, and current rehabilitation and medical management. Much of the pain and disability that follow a VCF may be minimized by addressing the psychological impact of such a fracture, using current medications to help limit bone loss and preserve bone mass, adhering to a well-planned rehabilitation program, and consideration of vertebroplasty or kyphoplasty in appropriate patients. A multifaceted approach will help to optimize recovery from a VCF related to osteoporosis.

Bone Density↗
PubMed2001

An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture.

STUDY DESIGN: Ex vivo biomechanical study using osteoporotic cadaveric vertebral bodies. OBJECTIVES: To determine if the inflatable bone tamp (tamp) restores height to compressed vertebral bodies and to compare the biomechanical properties of isolated, fractured osteoporotic vertebral bodies treated by kyphoplasty (tamp) or vertebroplasty. SUMMARY OF BACKGROUND DATA: Previous biomechanical studies have shown that vertebroplasty increases vertebral body strength and restores vertebral body stiffness, but does not restore vertebral body height lost as a result of compression fracture. METHODS: Compression fractures were experimentally created in 16 osteoporotic VBs assigned to either the tamp or percutaneous vertebroplasty group. The tamp treatment consisted of inserting balloon-like devices into the vertebral body, inflating the bone tamp, and filling the void with Simplex P (Howmedica, Rutherford, NJ) bone cement. The percutaneous vertebroplasty treatment consisted of directly injecting Cranioplastic bone cement (CMW, Blackpool, UK) into the vertebral body. Pre- and posttreatment heights were measured, and the repaired vertebral bodies were recompressed to determine posttreatment strength and stiffness values. RESULTS: The tamp treatment resulted in significant restoration (97%) of vertebral body height lost after compression, whereas percutaneous vertebroplasty treatment resulted in a significantly lower restoration of lost height (30%) (P < 0.05). Both treatments resulted in significantly stronger vertebral bodies relative to their initial state (P < 0.05). The tamp treatment restored vertebral body stiffness to initial values, but the percutaneous vertebroplasty treatment did not (P < 0.05). CONCLUSIONS: Tamp treatment resulted in significantly greater height restoration than did percutaneous vertebroplasty, without loss of vertebral body strength or stiffness.

Aged↗
PubMed2006

The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty.

PURPOSE: To prospectively assess the incidence, location, and possible causative mechanisms of new vertebral compression fractures (VCFs) in 66 symptomatic patients with osteoporotic VCFs treated with percutaneous vertebroplasty (PV) and to study the relation between new VCFs and back pain symptoms. MATERIALS AND METHODS: Sixty-six patients with 102 painful symptomatic VCFs were treated with PV. All patients had baseline total spinal magnetic resonance (MR) imaging. Follow-up MR imaging was performed at 3, 6, and 12 months to locate new VCFs. Visual analog scales for pain and pain medication consumption were used to assess clinical outcomes. The following characteristics were compared in patients with new VCFs after PV versus patients without new VCFs: patient age, sex, presence of secondary osteoporosis, bone mineral density, number of preexisting VCFs, shape and grade of VCFs, type of bone cement used for PV, volume of injected cement, and cement leakage in intervertebral disc spaces. RESULTS: Sixteen of 66 patients had 26 new VCFs during 1 year of follow-up after PV. Most new VCFs occurred within 3 months of PV, half of new VCFs appeared in levels adjacent to treated levels, and half of the new VCFs were symptomatic. The presence of more than two preexisting VCFs was the only independent risk factor for the development of a new VCF. CONCLUSIONS: New VCFs occurred after PV in 24% of patients. Half of new VCFs occurred in levels adjacent to treated levels and half were symptomatic. The presence of more than two preexisting VCFs was the only independent risk factor for the development of a new VCF.

Adult↗
PubMed2002

Percutaneous vertebroplasty: new treatment for vertebral compression fractures.

Interventional radiologists have been performing image-guided spinal procedures for many years. Percutaneous vertebroplasty is a newer technique in which a medical grade cement is injected though a needle into a painful fractured vertebral body. This stabilizes the fracture, allowing most patients to discontinue or significantly decrease analgesics and resume normal activity. The impact of this procedure on the morbidity and expense associated with symptomatic osteoporotic vertebral compression fractures in the United States may be significant. Patients who are unresponsive to conservative therapy of bed rest, analgesics, and back bracing should be considered for vertebroplasty. This procedure is contraindicated in patients with active infection, untreated coagulopathy, and certain types of fracture morphology. Because many patients have multiple chronic fractures, there should be a strong correlation between the physical examination signs, symptoms, and cross-sectional imaging findings. The success rate for this procedure in treating osteoporotic fractures is 73 to 90 percent. Vertebroplasty can effectively treat aggressive hemangiomas of the vertebral body and may be palliative in patients with malignant pathologic fractures. Significant complications of the procedure are less than 1 percent.

Bone Cements↗
PubMed2005

Classification of vertebral compression fractures in the osteoporotic spine.

OBJECTIVE: The purpose of this study was to clarify the relationship between initial radiographs of osteoporotic vertebral compression fractures (VCFs) and clinical results. METHODS: Of the 135 VCFs in the elderly, 73 consecutive patients (84 vertebrae) were reviewed retrospectively. All patients were treated without rigid immobilization. The subjects consisted of 15 men and 58 women. The mean age was 75.0 years with a range from 61 to 91 years. The early radiographic features were classified into five types based on lateral radiographs. Radiographic results during follow-up were evaluated according to the number of collapsed vertebrae and vacuum clefts. Clinical results were evaluated by Visual Analog Scale and activities of daily living. RESULTS: Of the five types, swelled-front-type, bow-shaped-type, and projecting-type fractures had a poor prognosis with late collapse and often showing a vacuum cleft. On the other hand, concave-type and dented-type fractures had a good prognosis and almost achieved fusion. Clinical results of 28 patients with vacuum clefts were fair at the final follow-up. Nineteen patients had little back pain, and nine patients experienced moderate back pain. Regarding the activities of daily living, four patients had difficulty walking.

Activities of Daily Living↗
PubMed1989

Vertebral compression fractures: distinction between benign and malignant causes with MR imaging.

Magnetic resonance (MR) imaging was performed on 64 patients with 109 vertebral compression fractures, the cause of which could not be determined from plain radiographs. Twenty-five fractures were due to malignancy; 84 were caused by a benign process. In 22 of the 25 fractures caused by malignancy, MR images showed complete replacement of normal bone marrow, whereas 47 of the 61 benign fractures without history of trauma had complete preservation of normal bone marrow. The remaining 14 benign fractures had incompletely preserved bone marrow in a regular pattern. In two of the three remaining malignant fractures, the bone marrow replacement also was incomplete but with an irregular pattern. In cases of recent trauma or primary bone marrow abnormalities, the configuration and signal of remaining bone marrow were not useful in differentiating among malignancy, osteoporosis, and other benign processes. When criteria based on complete loss or preservation of marrow and marrow configuration in cases of incomplete loss were used, the accuracy in differentiating benign from malignant fractures was 94%. MR imaging may be a useful adjunct in differentiating benign from metastatic fractures and may provide information not available with other imaging methods.

Adolescent↗
PubMed2006

Balloon kyphoplasty: an experience of 38 patients with painful osteoporotic vertebral compressive fractures.

OBJECTIVE: To evaluate the efficacy and safety of percutaneous balloon kyphoplasty as a new therapy for patients with painful osteoporotic vertebral compressive fractures of the lumbar and thoracic spine. METHODS: A retrospective analysis was conducted in 38 consecutive patients (28 females, 10 males), whose ages ranged from 56 to 82 years (mean age 72 years). The symptom- and sign-positive spinal segment was identified by MRI. The time between onset of symptoms and surgical intervention ranged from 2 days to 1 year. 62 segments (36 thoracic, 26 lumbar) were treated in this cohort. The pain score estimated by Visual Analog Scale and activity degree were assessed immediately after operation and at 1-, 6-, and 12-month postoperative follow-up. Preoperative and postoperative anterior, midline vertebral heights in fractured vertebrae were measured on lateral radiographs to evaluate the effect of the procedure. RESULTS: The method achieved a swift pain relief associated with an evidently increased weight-bearing ability. The pain score was reduced from 8.2 to 2.4 points. The anterior and midline vertebral heights in 62 fractured vertebral bodies increased up to 82.76%+/-26.84%, 88.82%+/-21.75% and the wedge decreased from 15 to 8 degrees. This effect persisted at least over a period of two years. The procedure did not induce narrowing of the spinal canal and no severe complications occurred. CONCLUSIONS: Balloon kyphoplasty can result in immediate clinical improvement of mobility and pain relief, increase vertebral body height, and quickly return patient's activity. The short-term results are approved excellent, and the long-term results need further judgment.

Aged↗